WITHDRAWN: Inadequate prevention, detection and early management of PPH: organizational determinants

Postpartum hemorrhage remains a leading cause of maternal morbidity and mortality, largely preventable. This study aimed to identify the organizational determinants of inadequate management of severe PPH using a previously established global adequacy score. This retrospective study included patients with severe primary PPH (≥1000 mL blood loss within 24 hours postpartum) in a French tertiary maternity unit from January 2019 to December 2021. Exclusion criteria were cases of antepartum or secondary , home deliveries, placenta accreta or praevia, uterine rupture, vaginal thrombus, vascular injury during cesarean section, deliveries before 24 weeks of gestation, and contraindications to second line uterotonics. Adequacy of care was evaluated using a composite global score. Inadequate care was defined as a score ≤ 25th percentile calculated among included women. Organizational determinants studied were number of deliveries within 12 hours, timing of PPH midwife and nurse transmission timing, medical turnover . Among 325 patients with severe PPH, 83 had an inadequate score (score ≤ 78.57%). Compared with the adequate care group, these women more frequently delivered par cesarean section, either elective or emergency (16.9 vs. 6.2% and 49.4 vs. 26.5%, p <0,001). PPH during weekday time was also more often in the adequate care group (49.4% vs. 30.6%, p =0.008). This global adequacy score identified organizational determinants, notably cesarean delivery and weekday time, associated with inadequate care of severe PPH. This approach could help other teams assess and improve PPH management according to local organizational determinants.